"One millimetre equals one degree": a simple way to achieve in 92% of cases the desired correction after opening proximal tibial osteotomy for genu varum.

Abstract

When performing a high tibial osteotomy (HTO) for genu varum deformity, it is not always easy to obtain the correct amount of overcorrection. The aims of this study were to review the results of a simple and reproducible method of correction that we have called "1mm equals 1°". We have applied this technique to the medial opening wedge osteotomy. Our hypothesis was that one degree of correction corresponded with one degree of opening. 97 proximal medial opening wedge osteotomies were measured intraoperatively with a navigation system and at 3months with long-leg X-rays. The hip-knee-ankle (HKA) angle preoperatively was on average 173.8 ± 2.3° (170°-177°). In most cases, an opening of 4° greater than the initial varus was performed using our formula that one degree varus was equal to 1mm of opening. In other words, when the varus was 6°, an opening of 10mm was performed. The void left by the opening wedge was filled with a calcium triphosphate wedge and the construct fixed and held with a locking plate. Aiming for a knee axis of 184 ± 2°, which corresponds to 2°-6° of overcorrection, we obtained the following results: HKA intraoperatively measured angle with navigation was on average 183.5 ± 0.9° (182°-184°) and HKA radiologically postoperatively angle was 182.5° ± 1.6° (179°-189°). We therefore achieved the desired overcorrection of 2°-6° in 92% of cases based on our postoperative radiographs and in 100% cases based on intraoperative measurements with computer navigation. The method of "1mm equals 1°" is a simple, reliable, and reproducible method to achieve in 92% of cases the desired overcorrection (i.e., 184 ± 2°) with valgising proximal medial opening wedge osteotomy in genu varum.